Patient Privacy

MARYLAND CENTER FOR NEURO-OPHTHALMOLOGY & NEURO-OTOLOGY, P.C.

NOTICE OF PRIVACY PRACTICES

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. The terms described in this notice will be available to all new patients and displayed where registration occurs in our office. Please read this information carefully.

OUR DUTY

MARYLAND CENTER FOR NEURO-OPHTHALMOLOGY & NEURO-OTOLOGY, P.C., is dedicated to protecting your medical information. We are required by law to maintain the privacy of your Protected Health Information (PHI), provide you with this Notice of Privacy Practices,and follow the information practices that are described in this notice.

Includes insurance information, payments and other related health information.

All new patients are required to sign new patient Consent to the Use and Disclosure of PHI for treatment, payment and healthcare operations.

USES AND DISCLOSURE OF HEALTH INFORMATION

MARYLAND CENTER FOR NEURO-OPHTHALMOLOGY & NEURO-OTOLOGY, P.C., may seek your consent to use health information about your treatment, to obtain payment for treatment, and for healthcare operations to evaluate the quality of health care that you receive. Listed below are some examples to describe the types of uses and disclosures of PHI that may be made by our office. The list is not meant to be all-inclusive.

Treatment

We will use and disclose your PHI to evaluate your health, diagnose your medical condition, and provide, coordinate or manage your health care and related services. For example, we may disclose your PHI:

To a physician to whom you have been referred or who has referred you to our office. The sharing of your health information may likely extend to additional parties involved in your care, such as other physicians, medical or lab technicians, and other legitimate hospital, medical office and healthcare workers who are not members of our medical practice staff;

To designated pharmacies or with health insurance carriers or other outside parties who may require prior authorization of your medical care or treatment plan;

In a message left on your home answering service/machine or cell phone regarding time- sensitive test results, follow-up appointments, and instructions unless you notify us of your objection.

Payment

Your PHI will be used, as needed, to obtain payment for the health care services we provide to you or recommend for you. This may include:

Bills for services may be sent to either you and /or a third-party payer with accompanying documentation that identifies you, your diagnoses and procedures performed.

Making a determination of eligibility or coverage for insurance benefits;

We may also utilize certain business associates to assist us with billing, payments, processing, reporting and collection.

Healthcare Operations

We may use or disclose your PHI, as needed, in order to support the MARYLAND CENTER FOR NEURO-OPHTHALMOLOGY & NEURO-OTOLOGY, P.C., business activities.These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, marketing and fundraising activities, and conducting or arranging for other business activities. For example, we may

Call you by name in the waiting room when your physician or other health care provider is ready to see you.

Use or disclose your PHI, as necessary, to contact you to remind you for your appointment or to obtain referral information.

Use or disclose your PHI, as necessary, to leave a message on your home or cell phone answering machine to remind you of your appointment

We may use and disclose your PHI for marketing and charitable community activities. For example:

Your name, mailing and email address may be used to send you news about our practice and any new services we may offer.

Your PHI may be used to send you information describing other health-related goods and services that we believe may interest you.

Uses and Disclosures of PHI That Require Your Written Authorization

Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted by law and/or described above. You may revoke this authorization at any time, in writing, except to the extent that your physician or MARYLAND CENTER FOR NEURO-OPHTHALMOLOGY & NEURO-OTOLOGY, P.C. has taken action in reliance on the use or disclosure permitted in the authorization. For example:

You will be required to fully complete and sign a medical records release authorization form in order to have copies of your medical records sent to another physician, insurance company, or hospital other than those involved in your treatment, payment for services, or our health care operations;

You will be required to fully complete and sign a medical records release authorization form in order to obtain copies of your medical records for your own use;

If you choose to sign an authorization to disclose information, you can later revoke the authorization to stop any future uses or disclosures.

Uses and Disclosures of PHI Without Written Authorization

The MARYLAND CENTER FOR NEURO-OPHTHALMOLOGY & NEURO-OTOLOGY, P.C., may use or disclose identifiable health information about you without your authorization for several reasons. Subject to certain requirements, we may give out health information without your authorization

For public health purposes, for auditing purposes and for emergencies;

When otherwise requested by law, such as for law enforcement in specific circumstances;

In any other situation, we will ask for your written authorization before using or disclosing any identifiable health information about you;

If you choose to sign an authorization to disclose information, you can later revoke the authorization to stop any future uses or disclosures.

INDIVIDUAL RIGHTS

In most cases, you have the right to look at or get a copy of health information about you that the MARYLAND CENTER FOR NEURO-OPHTHALMOLOGY & NEURO-OTOLOGY, P.C., uses to make decisions about you. You have the right:

To inspect and obtain a copy of your PHI.

If you request copies, we will charge you forcopying and postage

To request a restriction on the release of your PHI.

To request an amendment or corrections to your PHI.

To receive an accounting of certain disclosures we have made, if any, of your PHI.

To receive a list of instances where we disclosed health information about you for reasons other than treatment, payment, or related administrative purposes

To obtain a paper copy of this notice from us, upon request.

If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information. Any requests to inspect, to copy, or to amend your PHI must be submitted in writing to the attention of the contact listed at the bottom of this notice.

COMPLAINTS

If you are concerned that the MARYLAND CENTER FOR NEURO-OPHTHALMOLOGY & NEURO-OTOLOGY, P.C., has violated your privacy rights, or you disagree with a decision we made about access to your records, you may contact an office administrative assistant. Please note that we will not retaliate against you for filing a complaint.

A complaint must be filed within 180 days of when you knew, or should have known, that the act or omission complained of occurred. You also may send a written complaint to the U. S. Department of Health and Human Services:

MARYLAND CENTER FOR NEURO-OPHTHALMOLOGY & NEURO-OTOLOGY, P.C., may change our policies at any time. Before we make any significant changes in our policies, we will change our notices and post the new notice in the waiting area. You can also request a copy of our notice at any time. For more information about or privacy practices, contact an office administrative assistant.